| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,126 |
918 |
$255K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,656 |
843 |
$168K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
882 |
360 |
$93K |
| D2394 |
|
502 |
313 |
$74K |
| D1110 |
Prophylaxis - adult |
1,600 |
1,555 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
2,116 |
2,066 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,279 |
1,204 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,019 |
1,963 |
$46K |
| D0330 |
Panoramic radiographic image |
879 |
834 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,379 |
1,318 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,527 |
2,369 |
$35K |
| D1206 |
Topical application of fluoride varnish |
2,231 |
2,146 |
$34K |
| D1120 |
Prophylaxis - child |
1,123 |
1,090 |
$30K |
| D4355 |
|
395 |
381 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
750 |
707 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
311 |
204 |
$25K |
| D2332 |
|
259 |
99 |
$22K |
| D2335 |
|
137 |
66 |
$13K |
| D0272 |
Bitewings - two radiographic images |
501 |
486 |
$9K |